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191 Cards in this Set

  • Front
  • Back
MV auscultation
apex
TV auscultation
left parasternal border
AV auscultation
right 2nd intercostal space
PV auscultation
left 2nd intercostal space
Sl
closure MV and TV
S2
closure AV and PV
Inspiration
split in A2 and P2; due to increased blood in right side of heart
S3
abnormal; due to blood entering volume overloaded ventricle in early diastole
Causes of S3
valve regurgitation; congestive heart failure
S4
abnormal; due to blood entering non-compliant ventricle with atrial contraction in late diastole
Causes of S4
volume overloaded ventricle, hypertrophy
Murmurs
stretching valve ring or damage to valve
Inspiration
increases right sided abnormal heart sounds and murmurs
Expiration
increases left sided abnormal heart sounds and murmurs
Stenosis murmurs
problem in opening valve
Regurgitation murmurs
problem in closing valve
Valves opening in systole
AV and PV
Valves opening in diastole
MV and TV
Valves closing in systole
MV and TV
Valves closing in diastole
AV and PV
LDL
primary vehicle for carrying cholesterol
VLDL
primary vehicle for carrying liver-synthesized triglyceride
Familial hypercholesterolemia (type II):
AD; deficiency of LDL receptors; inc LDL
Type III hyperlipoproteinemia
deficiency apo E; T remnants (chylomicron, intermediate density)
Type IV hyperlipoproteinemia
inc VLDL; alcoholics
Apo B deficiency
deficiency apo B48 (chylomicrons) and B 100 (VLDL); L CH and TG
Clinical findings in apo B deficiency
malabsorption; hemolytic anemia
Atherosclerosis
reaction to injury of endothelial cells
Risk factors of atherosclerosis
smoking, T LDL, T homocysteine, Chlamydiapneumoniae infection
Cells involved in atherosclerosis
platelets, macrophages, smooth muscle cells, T cells with cytokine release
Fibrous plaque
pathognomonic lesion of atherosclerosis
C-reactive protein
marker of an inflammatory atheromatous plaque
Inflammatory atheromatous plaque
predisposes to platelet thrombosis
Increased plasma homocysteine
inc vessel thrombosis; folate (MC)/vitamin B12 deficiency
Hyaline arteriolosclerosis
small vessel disease of DM and hypertension; excess protein in vessel wall
Mechanisms of hyaline arteriolosclerosis in DM
non-enzymatic glycosylation
Non-enzymatic glycosylation
glucose attaches to amino acids in BM; causes inc permeability to protein
Mechanisms hyaline arteriolosclerosis in hypertension
pressure pushes proteins into vessel wall
Abdominal aortic aneurysm rupture
due to atherosclerosis; flank pain, hypotension, pulsatile mass
Syphilitic aneurysm
vasculitis of vasa vasorum of aortic arch; aortic regurgitation
Aortic dissection
due to hypertension and collagen tissue disorders (e.g., Marfan)
Cystic medial degeneration
elastic tissue degeneration creates spaces filled with mucopolysaccharides
Intimal tear in aorta
due to wall stress from hypertension and structural weakness
Types of dissection
proximal (MC); distal or combination of both
S/S proximal aortic dissection
chest pain radiating to back, lack of pulse; cardiac tamponade MC COD
Marfan's
AD; fibrillin defect; aortic regurgitation/dissection; lens dislocation; MVP with sudden death
MC COD Marfan's and Ehlers Danlos
aortic dissection
Phlebothrombosis
stasis of blood flow; deep veins below knee MC site
Pulmonary thromboembolism
emboli originate from femoral veins
Superficial migratory thrombophlebitis
sign of carcinoma of head of pancreas
Thoracic outlet syndrome
absent radial pulse with positional change
Turner's syndrome
lymphedema hands/feet in newborn; preductal coarctation
Spider telangiectasia
arteriovenous fistula; due to hyperestrinism (cirrhosis, pregnancy)
Capillary hemangioma in newborn
regress with age; do not surgically remove
Kaposi's sarcoma
HHN-8; vascular malignancy; MC cancer in AIDS
Bacillary angiomatosis
Bartonella henselae; vascular infection in AIDS
Small vessel vasculitis
palpable purpura; e.g., Henoch Schonlein purpura
Muscular artery vasculitis
vessel thrombosis with infarction; e.g., classical polyarteritis nodosa
Elastic artery vasculitis
absent pulse, stroke
Takayasu's arteritis
pulseless disease young Asian woman
Giant cell arteritis
temporal artery granulomatous vasculitis; ipsilateral blindness (ophthalmic artery)
Classical polyarteritis nodosa
muscular artery vasculitis with vessel thrombosis infarction
Path findings of Classical polyarteritis nodosa
vessel inflammation at different stages; aneurysms from vessel weakness
S/S of Classical polyarteritis nodosa
infarctions in kidneys, skin, GI tract, heart; HBsAg in 30%
Diagnosis of polyarteritis nodosa
angiography identifies aneurysms and thrombosis
Kawasaki's disease
coronary artery vasculitis/ thrombosis/ aneurysms in children
S/S of Kawasaki's disease
chest pain; desquamating rash; swelling hands/feet; cervical lymphadenopathy
Rx: IV gamma-globulin
Buerger's disease (thromboangiitis obliterans):
smoker's digital vasculitis; digital infarction
Raynaud's syndrome
digital vasculitis in PSS and CREST syndrome
S/S of Raynaud's Syndrome
digital pain; white-blue-red color changes
Cryoglobulinemia
protein gels in cold temperature; Raynaud's syndrome; HCV association
Cryoglobulinemia S/S
acral cyanosis relieved by coming indoors
Wegener's granulomatosis
association with c-ANCA; sinusitis, lung infarction, crescentic GN
Microscopic polyangiitis
palpable purpura; crescentic GN; association with p-ANCA
Henoch-Schonlein purpura
IgA-anti-IgA ICs; palpable purpura buttocks/legs; arthritis; IgA GN
Serum sickness vasculitis
e.g., horse antivenin in Rx of rattlesnake envenomation
Rocky Mtn spotted fever
tick borne Rickettsia infection; vasculitis causes petechia on palms -> trunk
Meningococcemia
sepsis causes petechia/ecchymoses; potential for Waterhouse Friderichsen syndrome
Essential HTN blacks
defect in renal excretion of sodium; inc plasma volume, dec PRA
Renovascular HTN
atherosclerosis renal artery in men; fibromuscular hyperplasia renal artery women
S/S of Renovascular HTN
epigastric bruit; inc PRA affected kidney, dec PRA unaffected kidney
Endocrine HTN
primary HPTH, Graves/ hypothyroidism, Cushings, primary aldosteronism, pheochromocytoma
Hypertension
LVH MC complication; AMI MC COD followed by stroke and renal failure
Afterload
resistance ventricles contract against
Preload
volume ventricles must eject
Concentric LVH
increased afterload; e.g., essential HTN, aortic stenosis
LVH with dilation/hypertrophy
increased preload; e.g., valve regurgitation; left to right shunts
LHF
forward failure; pulmonary edema, pillow orthopnea, paroxysmal nocturnal dyspnea
Systolic dysfunction
LHF due to decreased ventricular contractility (ischemia)
Diastolic dysfunction
LHF due to decreased ventricular compliance (hypertrophy)
RHF
backward failure; T venous hydrostatic pressure; neck vein distention, hepatomegaly, edema
ACE inhibitors
decrease afterload and preload in heart failure
Diuretics in CHF
reduce preload
Non-pharmacologic Rx in CHF
restrict salt and water
Ant. MI
MC COD in United States; left anterior descending coronary artery thrombosis MCC
Exertional angina
coronary artery atherosclerosis; subendocardial ischemia; ST depression
Prinzmetal's angina
coronary artery vasospasm; transmural ischemia; ST elevation
Sudden cardiac death
death within 1 hr of symptoms
Path findings in sudden cardiac death
severe coronary artery atherosclerosis; absence of occlusive thrombosis
LAD coronary artery
anterior portion left ventricle, anterior 2/3rds IVS
RCA (coronary artery)
posterior portion left ventricle and papillary muscle, inferior 1/3rd IVS, right ventricle
Acure MI
rupture of inflammatory plaque produces platelet thrombus
Ventricular fibrillation
MC COD in Acute. MI
Acute MI
no gross changes until 24 hrs
S/S of Acute MI
retrosternal pain radiating down arms, diaphoresis
Acute MI ruptures
3rd-7th day
Anterior wall rupture
MC type; LAD thrombosis; cardiac tamponade
Posteromedial papillary muscle rupture
RCA thrombosis; mitral regurgitation with LHF
IVS rupture
LAD thrombosis; left to right shunt; RHF
Mural thrombus
anterior Acute MI; danger embolization
Pericarditis
first week in transmural Acute MI; 6 wks later autoimmune
S/S of Pericarditis
friction rub; leaning forward relieves pain
Ventricular aneurysms
late manifestation of Acute MI; precordial systolic bulge; CHF MC COD
Right ventricular infarction
RCA thrombosis; hypotension, RHF, preserved left ventricular function
Diagnosis of Acute MI:
CK-MB and troponins; CK-MB absent by 3 days; troponins last 7-10 days
LDH isoenzymes
no longer used; LDH 1/2 flip indicates Acute MI
Reinfarction
reappearance CK-MB after 3 days
ECG findings in Acute MI
inverted T waves; ST elevation; Q waves
Ejection fraction
EF = stroke volume/left ventricular end-diastolic volume; 80/120 = 0.66
By-pass surgery
use internal mammary artery and saphenous veins ("arterialize" after 10 yrs)
Angioplasty complication
localized dissection with thrombosis
Umbilical vein
highest O2 saturation
Ductus arteriosis in fetus
shunts blood from pulmonary artery to aorta; PGE keeps it open
Ductus arteriosus in newborn
closes and becomes ligamentum arteriosum
Eisenmenger's syndrome
cyanosis due to reversal of left to right shunt
VSD
MC congenital heart disease; inc Sa02 right ventricle (RV), pulmonary artery (PA)
ASD
patent foramen ovale; inc Sa02 right atrium (RA), RV, PA; MC adult congenital heart disease
Down syndrome and heart disease
endocardial cushion defect (combined ASD and VSD)
PDA
machinery murmur; close with indomethacin; inc Sa02 PA
Tetralogy of Fallot
degree of pulmonic stenosis determines if cyanosis is present
Tetralogy of Fallot
decreased SaO2 in left ventricle, aorta
Tetralogy of Fallot
ASD and PDA are cardioprotective
Complete transposition
cyanosis; aorta empties RV; PA empties left ventricle
Complications cyanotic heart disease
secondary polycythemia; infective endocarditis; metastatic abscesses
Pre-ductal coarctation
Turner's syndrome
Post-ductal coarctation
constriction distal to ligamentum arteriosum
S/S of post-ductal coarctation
upper extremity HTN; claudication; rib-notching; activation RAA also causes HTN
Acute rheumatic fever
type II hypersensitivity; group A streptococcus pharyngeal infection
Acute rheumatic fever
sterile vegetations mitral valve (regurgitation); myocarditis with Aschoff nodule
S/S of Acute rheumatic fever
polyarthritis (MC), carditis, erythema marginatum, rheumatoid nodules, chorea
Mitral stenosis
chronic rheumatic fever; opening snap followed by mid-diastolic rumble
Mitral stenosis
left atrial dilation/hypertrophy- atrial fibrillation, thrombus, pulmonary edema, RHF
Mitral Valve Prolapse
myxomatous degeneration of mitral valve; common in Marfan syndrome, Ehlers Danlos
Mitral Valve Prolapse S/S
mid-systolic click followed by a murmur; palpitations, chest pain, rupture of chordae
Mitral Valve Prolapse click/murmur close to S1
decrease preload (stand, Valsalva, anxiety)
Mitral Valve Prolapse click/murmur close to S2
increase preload (supine, squat, clench fist)
Mitral regurgitation
pansystolic murmur; S3 and S4 common
Causes of mitral regurg
LHF, infective endocarditis, acute rheumatic fever
Aortic stenosis
systolic ejection murmur; syncope and angina with exercise; hemolytic anemia
Aortic stenosis murmur increased preload
worsens obstruction and increases murmur intensity
Aortic stenosis murmur with decreased afterload
decreases obstruction and decreases murmur intensity
Causes of aortic stenosis
bicuspid aortic valve; age-related sclerosis
Aortic regurgitation
bounding pulses; early diastolic blowing murmur
Austin Flint murmur
diastolic murmur; regurgitant flow on anterior leaflet mitral valve
Significance Austin Flint murmur
sign for AV replacement
Causes of aortic regurgitation
essential HTN, infective endocarditis, acute rheumatic fever, dissection
Tricuspid regurgitation
pansystolic murmur increases intensity with inspiration
Causes of tricuspid regurgitation
endocarditis IV drug abuse; RHF; carcinoid heart disease
Carcinoid heart disease
tricuspid regurgitation, pulmonic stenosis
Infective endocarditis (IE):
Streptococcus viridans MCC; Staphylococcus aureus MCC IVDA IE prosthetic heart valve: Staphylococcus epidermidis (coagulase negative)
IE ulcerative bowel disease
Streptococcus bovis
S/S of IE ulcerative bowel disease
IC vasculitis- Roth spot, splinter hemorrhages; regurgitant murmurs; metastatic abscesses
Lab findings of IE ulcerative bowel disease
positive blood culture
Libman Sacks endocarditis
sterile vegetations mitral valve associated with SLE
Coxsackievirus and heart disease
MCC of myocarditis (lymphocyte infiltrate in myocardium) and pericarditis
Parasitic cause of myocarditis
leishmania in Chagas disease
Pericardial effusion
all chamber pressures are uniformally increased
S/S of pericardial effusion
muffled heart sounds, pulsus paradoxus, inspiratory neck vein distention
Dx and Rx of pericardial effusion
echocardiogram, pericardiocentesis, respectively
Pulsus paradoxus
drop in blood pressure > 10 mm Hg with inspiration
Constrictive pericarditis
TB MCC worldwide; pericardial knock
Congestive cardiomyopathy
generalized chamber enlargement; low ejection fraction
Causes of congestive cardiomyopathy
postpartum, cardiotoxic drugs, hypothyroidism, alcohol
Hypertrophic cardiomyopathy
MCC of sudden death in young person (due to conduction defects)
Site of obstruction in hypertrophic cardiomyopathy
anterior leaflet mitral valve drawn against asymmetric thickened IVS
Effect decreased preload on systolic murmur
worsens obstruction and increases murmur intensity
Effect increased preload on systolic murmur
reduces obstruction and decreases murmur intensity
Restrictive cardiomyopathy
decreased compliance
Causes of restrictive cardiomyopathy
iron, amyloid, glycogen; sarcoidosis; tropical endocardial fibrosis
Cardiac myxoma
benign tumor left atrium; embolization; syncope
Cardiac rhabdomyoma
childhood tumor; association with tuberous sclerosis
U wave
hypokalemia; MCC diuretic therapy (e.g., thiazides; loop diuretics)
Peaked T wave
hyperkalemia; MCC renal failure
ST depression
subendocardial ischemia (e.g., classical angina pectoris).
ST elevation
transmural ischemia (e.g., AMI), pericarditis, ventricular aneurysm
Atrial fibrillation
MC chronic arrhythmia; absent P waves; danger for embolization
Ventricular premature beats
wide QRS complexes; MC arrhythmia in coronary care unit
Ventricular fibrillation
MCC of death in an Acute MI
Anterior Acute MI
Q waves I VI-V4
Inferior Acute MI
Q waves in II, III, and aVF. Right coronary artery thrombosis
Wolff-Parkinson-White
short PR interval with normal P wave; delta wave on upstroke of R wave